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State Children’s Health Insurance Program ChartsSeptember 30, 2003
About SCHIPThe State Children's Health Insurance Program (SCHIP), created by the Balanced Budget Act of 1997, enacted Title XXI of the Social Security Act and allocated about $20 billion over five years to help states insure more children. SCHIP continues to receive considerable attention as states implement or continue to expand and refine their initial SCHIP plans. SCHIP plans have been approved in all 50 states, Washington DC and 5 territories. States face challenges and implementation issues related to finding and enrolling eligible children, ensuring that health plans and services are available to meet their needs, and that the programs improve children's health status. In an effort to provide information on state actions involving SCHIP, this webpage contains several resources on general SCHIP issues as well as more detailed information on implementation topics such as outreach plans and specialized coverage. State SummariesThe Health Division of the Center for Best Practices at the National Governor's Association periodically updates summaries of each state's SCHIP plan. These summaries may be found by clicking here. List of ChartsInformation SourcesInformation sources used in these charts included state Title XXI plans, evaluations submitted to the Centers for Medicare and Medicaid Services (CMS), approved amendments, and a periodic survey of SCHIP directors (last conducted in the Fall of 2003), in addition to the following sources.
GlossaryCAHPS Consumer Assessment of Health Plans (CAHPS) is a kit of survey and reporting tools to help consumers and purchasers assess and choose a health plan. The Agency for Health Care Policy and Research at the U.S. Department of Health and Human Services developed the questionnaires. CMS The Centers for Medicare and Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services. CMS runs the Medicare and Medicaid programs-two national health care programs that benefit about 75 million Americans. Along with the Health Resources and Services Administration (HRSA), CMS runs the State Children's Health Insurance Program (SCHIP), a program that covered approximately 5.8 million uninsured children in the United States in Federal Fiscal Year 2003. CMS, formerly known as the Health Care Financing Administration (HCFA), underwent reform in 2001. CMS established three new business centers in 2001 as part of the reform: the Center for 0Beneficiary Choices, the Center for Medicare Management, and the Center for Medicaid and State Operations. CARVE OUT When services are “carved out,” managed care plans are not contractually obligated to provide them. States may establish a separate, capitated system for these services or allow beneficiaries to visit any other Medicaid provider to receive these services. CROWD OUT Crowd out, also known as substitution, occurs when individuals or employers drop employer-sponsored or individual health insurance coverage and enroll in a public insurance program. Title XXI requires states to include measures to prevent crowd out. CSHCN Children with special health care needs (CSHCN) are those who have or are at increased risk of chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services that extend beyond the type and amount generally required by children. Conditions of risk may be diagnosed disorders; events that occur during prenatal, perinatal or neonatal periods; and environmental conditions, such as poverty and family stress. DCO A dental care organization (DCO)-the dental equivalent of an MCO-combines delivery and financing of dental services. The entity generally receives a prepaid, capitated premium and assumes financial risk for the services provided to beneficiaries. ESI Children can be covered by employer-sponsored insurance (ESI) as a dependent of a parent who is covered through an employer. FACCT The Foundation for Accountability (FACCT) is a consortium of purchaser and consumer organizations, with an emphasis on patient-centered, outcome measures. Three states currently use FACCT’s measurement tools to assess quality of care in SCHIP. FMAP The federal medical assistance percentage (FMAP) is the rate at which the federal government shares in the medical assistance expenditures of a state’s Medicaid program. A state’s FMAP is determined through a formula comparing the average per capita income of the state against the national average. States with a lower average per capita income receive a higher FMAP, while states with higher per capita incomes receive a lower FMAP. The federal government revises FMAP rates annually. States receive an “enhanced FMAP” for SCHIP. The enhanced FMAP is determined by taking 70 percent of the FMAP and adding 30 percentage points, up to 85 percent maximum. The U.S. Department of Health and Human Services publishes FMAP and enhanced FMAP rates in the Federal Register annually.
FPL The federal poverty level (FPL) refers to the U.S. Department of Health and Human Services' poverty guidelines, published each year in the Federal Register. FFS Fee-for-service (FFS) is a payment system in which doctors, hospitals and other providers are paid for each service performed. FFY See FY below. FY There are state and federal fiscal year (FY) time periods. Forty-six states plus the District of Columbia use July 1 through June 30 as the state FY (SFY). New York's FY is April 1 to March 30. Texas's FY is September 1 to August 31. The federal FY (FFY) begins October 1 and ends September 30. HEDIS The Health Plan Employer Data and Information Set (HEDIS) is a standardized set of performance measures that assesses the performance of health plans on a number of elements, including access and quality of care. The National Committee for Quality Assurance (NCQA) sponsors, supports and maintains HEDIS. HIFA The Health Insurance Flexibility and Accountability Demonstration Initiative (HIFA) is an 1115 waiver program. HIFA waivers allow states to demonstrate budget neutral methods of expanding private insurance coverage to targeted uninsured populations below 200 percent of the federal poverty level. HMO A health maintenance organization (HMO) is an entity that contracts on a prepaid, capitated risk basis to provide comprehensive health services to beneficiaries. MCO A managed care organization (MCO) combines health care delivery and financing of services. The entity generally receives a prepaid, capitated premium and assumes financial risk for the services provided to beneficiaries. PCP The primary care coordinator (PCC), primary care provider (PCP), or primary care manager (PCM) is the physician or provider who serves as the initial contact between the member and the medical care system and is responsible for coordinating the treatment of members assigned to his or her panel. QARI The Health Care Financing Administration developed the Quality Assurance Reform Initiative (QARI) for use in state-based programs for Medicaid managed care plans. QARI’s emphasis is on plans’ internal quality improvement mechanisms. SECTION 1115 WAIVER Medicaid research and demonstration (Section 1115) waivers are normally used to make broad changes in eligibility, services or the service delivery system. SECTION 1915(b) WAIVER Freedom of choice or Section 1915(b) waivers allow states to place beneficiaries in a primary care case management program (PCCM), which is run on a "managed" fee-for-service basis using a gatekeeper concept, or in a prepaid capitated arrangement. SFY See FY above. TITLE V Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services, administers Title V, the Maternal and Child Health (MCH) Services block grant program. The block grant program has three components: formula block grants to 50 states, three territories, and three commonwealths; special projects of regional and national significance (SPRANS); and community integrated service systems (CISS) grants. TITLE XIX Title XIX of the Social Security Act is the Medicaid program, which provides medical assistance for certain individuals and families with low incomes and resources. Medicaid was established in 1965 as a joint federal-state program. TITLE XXI The Balanced Budget Act of 1997 created Title XXI of the Social Security Act, also referred to as the State Children's Health Insurance Program. Support for this page and associated State Children's Health Insurance Program charts was provided through a generous grant from the David and Lucile Packard Foundation.
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